Barodontalgia, commonly known as tooth squeeze and previously known as aerodontalgia, is a pain in tooth caused by a change in atmospheric pressure. The pain usually ceases at ground level.[1][2][3] The most common victims are SCUBA divers because in deep dives pressures can increase by several atmospheres,[4] and military pilots because of rapid changes.[5][6][7][8] In pilots, barodontalgia may be severe enough to cause premature cessation of flights.[9]

Most of the available data regarding barodontalgia is derived from high-altitude chamber simulations rather than actual flights. Barodontalgia prevalence was between 0.7% and 2% in the 1940s, and 0.3% in the 1960s.[7]

Similarly, cases of barodontalgia were reported in 0.3% of high altitude-chamber simulations in the Luftwaffe.[10]

The rate of barodontalgia was about 1 case per 100 flight-years in the IsraeliAir Force.[11] During World War II, about one-tenth of American aircrews had one or more episodes of barodontalgia.[9] In a recent study, 8.2% of 331 Israeli Air Force aircrews, reported at least one episode of barodontalgia.[11]

Barodontalgia is a symptom of dental disease, for example inflammatorycyst in the mandible.[12] Indeed, most of the common oral pathologies have been reported as possible sources of barodontalgia: dental caries, defective tooth restoration, pulpitis, pulp necrosis, apical periodontitis, periodontal pockets, impacted teeth, and mucous retention cysts. One exception is barodontalgia manifested as referred pain from barosinusitis or barotitis-media. The latter two conditions are generated from pressure changes rather than pressure-related flare-up of pre-existing conditions.[13] A meta-analysis of studies conducted between 2001 and 2010[14] reveled a rate of 5 episodes/1,000 flight-years. Maxillary and mandibulardentitions were affected equally in flight, but in diving, maxillary dentition was affected more than the mandibular dentition, which can indicate a greater role for maxillary sinus pathology in diving barodontalgia.[14] Surprisingly, despite cabin pressurization - the current in-flight barodontalgia incidence is similar to the incidence in the first half of the 20th century; despite the more fluctuation in divers' pressures - the weighted incidence of barodontalgia among aircrews are similar to the weighted incidence among divers; and as opposed to a common belief, and in contrast to diving conditions - the role of facial barotrauma in the etiology of in-flight barodontalgia is only minor (about one-tenth of cases).[14]

The Fédération dentaire internationale describes 4 classes of barodontalgia.[1] The classes are based on signs and symptoms. They also provide specific and valuable recommendations for therapeutic intervention.[1]